Author: Nurse Practitioners Save Lives

Barbara Phillips is one of the most savy nurse practitioners that I know. She is an independent nurse practitioner based in Washington state and spends a LOT of time after her practice hours to keep us up to speed on how to start your own nurse practitioner office. There are also ways to have a NP practice online as well. She sent me an email recently and mentioned that I might want to post about it here. You can better believe this is a teleseminar you won’t want to miss.

“Just wanted to let you know that I’m doing a teleseminar on 4/25/10 on Getting Started In Your Own Practice. I will be launching a bootcamp from this call.”
I am a member of her website even though I am not ready to become an independent NP yet. (One day I would like to) It’s great reading material and the message boards have loads of great NPs collaborating together “getting it done!”

Pop on over from the banner link below and tell her I sent you. You won’t regret checking out her resources.

Cheers!

Change of Shift is up over at Nurse Me. She was nice enough to enter my entry without my sending one in this time. I am enjoying the edition of the new doctor at the office and will enjoy being caught up on paperwork so I can blog more. Click here for the COS!

I was visiting Barbara Phillip’s Facebook site and noticed a question that was presented regarding collaborating MD and NP’s working together and the concern about stealing their patients. This is a valid concern when one has already established a practice and needs someone to take the edge off due to a volume of new patients. In fact, this is the exact scenario that is occurring in the office I work at now. The following reply is what I said on Barb’s facebook.

I think that you cannot steal a patient who is totally satisfied with their care. I have a new MD coming into the office in a few weeks and my patients are concerned that they will be made to see him instead of me which is not true. He gets the new patients and I keep mine. I see my other collaborating MD’s patients if he is not available and he does the same for me. A few have switched from his side to me and vice versa but not enough to concern me. If I saw a a drastic move over, I would have to seriously evaluate my practice technique. We use anonymous surveys at the office in order to ascertain patient satisfaction good or bad.

What do you think about “stealing patients”? Do you think that it’s really effecting MDs who hire NPs?

They say that time dulls the memory of painful experiences. For the most part, it’s true. Before I had my partial hysterectomy, I had the wonderful(tongue in cheek) experience of several ovarian cyst ruptures. I could almost set my watch and predict when they would occur. The very first one that I had as a 16 year old woke me from a sound sleep and I thought my appendix had ruptured. I was put on birth control pills to control them and it worked for a while.

Time went by and I also developed uterine fibroids so I was scheduled for a partial hysterectomy and I tried to talk the doc into a total but he wouldn’t “put me into menopause” at 35. So when I awoke, he was happy to tell me that he had cleaned up a large hemorrhagic cyst on the left one and decided to leave it in there. I KNEW that it would come back to haunt me.

The pain almost made me want to throw up and I had to lay in a hot bath for an hour and then go straight to bed. Another one like that and I will consider yanking the left ovary as well. Thank goodness I have only had 3 or 4 major blowouts in the last 6 years.

Being a female provider makes me much more sympathetic to abdominal pain complaints regarding ovarian cysts and I try to educate my female patients to mark their calendars so that they can help me diagnose them.

Ohhhh the aaaa—goooo—neeey!

S188 GENERAL BILL by Bennett (Similar H 0677)
Advanced Registered Nurse Practitioners [SPSC]; Redefines the term
“practitioner” for purposes of the Florida Comprehensive Drug Abuse
Prevention and Control Act to include advanced registered nurse
practitioners. EFFECTIVE DATE: Upon becoming law.
10/05/09 SENATE Filed
12/09/09 SENATE Referred to Health Regulation; Criminal Justice
03/02/10 SENATE Introduced, referred to Health Regulation; Criminal Justice
-SJ 00022

Once again, the Florida Senate is voting on whether or not Nurse Practitioners can have prescriptive authority for controlled substances. I’m not sure what it means to be referred to Health Regulation; Criminal Justice but I hope that it gets passed this year.

One of the things that slows down my practice is the fact that I must call in prescriptions needed for my patients under my collaborating MD. Because he only works one day a week, it makes his job a bit harder because he has to sit and review my charts that I have called in over the week prior. Most of the patients he is familiar with so it’s a nuisance but he has to review all of the documentation such as MRIs and such too besides trying to see his own patients. Through working with me he knows that I screen very well against drug seekers and actually am tighter about giving narcotics than he is.

I sometimes forget to call in the scripts because I am so busy moving onto other patients and the office nurse has to backtrack for me and call the patient to let them know that it was done. I also have to stay late on Fridays to make sure that everyone is covered so that I don’t get calls over the weekend for narcs and not having their chart at home.

Anyone know anything more about the bill’s status, keep us updated!

Here’s another picture that my husband entered into the Art show that I thought would have won. It’s our son Michael who completed his first year in the Navy recently. We are so proud of him. He will be based in Jacksonville soon for some of his training which is about 1 1/2 hours from here. Can’t wait!

Hello to all! Sometimes I just have to go off topic and talk about family things. For those of you who will comment just to complain, tough. For those of you who read blogs for a well rounded topic list, here goes!

My husband is a photojournalist and works freelance for our local newspaper. He has entered some of his photography into two juried shows and won first place overall recently for a picture of one of my son’s friends in Chicago on a train. We were up there celebrating their graduation from Navy basic training when my husband noticed that he had nodded off to sleep. It was the first day trip the guys had since they started training. Since my husband is a huge supporter of the military and a big history buff, he put the picture into black and white in order to give it a more WWII look.

The judge of the show told him that she was very touched by the photo and wished that others who entered their art realized that it was not all about how pretty or big an entry was but rather how it touched people’s souls and made them think. The name of the entry is “Home”.

I am so proud of my husband and look forward to many more years of his pictures. Feel free to leave a comment unless you are a spammer of course! Those get kind of boring to go through and reject. It’s really just a waste of time you know…. Hint hint hint!! Stop typing the spam comments now please. Sigh… I knew it wouldn’t work.

A Call for Hospice Reform: Nurse Practitioners Lead the Way | GeriPal – A Geriatrics and Palliative Care Blog

My great grandmother passed after a short battle with pneumonia recently and spent the last two days of her life in Hospice. I am so grateful for their care of her after struggling in the hospital for 5 long tortuous hours crying in pain and shortness of breath. She begged for help and my sister had to drag the doctor into the room and threaten to put a pillow over her head in order to alleviate her suffering. Why do we let patients go through this when the transition can be so much more comfortable? I am glad that I didn’t have to watch that process. I may have lost my professional composure.

I don’t understand why we still allow patients to suffer in their final moments. It should be a joyous transition at least for most. I am sure that for some it is a scary place not knowing what is on the other side. I think that we wait way too long into the process to start the journey and it turns into chaos and terror. Hospice care should be individualized and we should treat the disease process symptoms in order to make the process as comfortable as possible. Give diuretics in congestive heart failure and oxygen support for shortness of breath etc. not just morphine and ativan to dull the patient down into death. We don’t need to hasten the process. We need to find ways to make it an easier transition.

Please read this article on utilizing nurse practitioners in hospice care.

May you rest in peace Grandma Leona!

Some of my patients ask me what information an insurance company can get when their labs are done. I hadn’t really put that much thought into the process until recently. One of my patients had a urine drug lab done and I received a copy of it. I was shocked to find out just what is being screened for in the test.

Think about it for a minute. One would think that just the illicit drugs are looked for, but the following also shows up on the test.

Antibiotics, Diphenhydramine, Caffeine, Ephedrines, Nicotine, Phentermine, Salicylate, Cimetidine, Antidepressants, Antihypertensives and Diuretics.

Mmmmmm aybe I don’t want my insurance company to know that I have seasonal allergies and that I take a baby aspirin as a preventative because my Mom has hypertension. How about whether or not I have reflux when I eat spicy foods? Maybe I bloat a little around my menstrual cycle and I want to pee off some fluid? I live on Pepsi. I know it’s not good for me, but I am actually shocked that it could be detected.

There has been talk of trying to ban foods and drinks that cause us to be obese and I understand the health reasons as a provider. I don’t want anyone in the government telling me what I can and cannot eat. No one but me puts the food in my mouth. Only I am responsible for my own actions.

It’s already bad enough that people can be banned from having insurance due to their health conditions and yes, some are their own fault, but what do you think about this issue?

Nasal carriers of S aureus infection have a high risk for healthcare-associated infection 3 to 6 times that of noncarriers, and more than 80% of healthcare-associated S aureus infections are endogenous. Although intranasal application of mupirocin ointment has been shown to prevent invasive infection in patients receiving dialysis, the results with surgical patients have been controversial. The authors proposed that adding skin cleansing with chlorhexidine gluconate soap would improve outcomes of S aureus infection in hospitalized patients.

The above study was conducted recently and printed January 7, 2010, issue of the New England Journal of Medicine. Ask my patients what I’ve been doing for the last two years in my office. I learned that regimen from the hospital where I worked as a floor nurse from the surgical group. This is not something that most providers know by now.

The area that I work here in North Florida is a hotbed of MRSA and almost daily I get patients in with complaints of chronic boils and spider bites. I still have to shake my head over the continued misunderstanding of the process of bacterial resistance. This is the main reason that I stress to all of my patients the need to finish an antibiotic and to only take one if it’s indicated. Too many want instant results and ask for an additional antibiotic before the first one has had time to take effect.

The regimen that I have used for the last two years is Hibaclens body wash daily x 10 days while on antibiotics and Mupricion ointment to nares twice daily x 7-10 days. Usually the MRSA is reactive to Septra DS or Cipro. In some rare cases, Rifampin or Tetracycline is used for resistant strains. Hand washing is so important and teaching patients to wipe off grocery carts. The first place people often go after discharge from a hospital is to Walmart. We all know that insurance companies are requiring much shorter stays and people are still contagious.

Protect yourself through education and proper use of antibiotics out there!

Change of Shift is up at Emergiblog! Get it while it’s hot! Here’s a link to the page where you can find the current edition and all of the past!

I keep seeing articles regarding the wait times of the Emergency rooms and questions regarding suggestions of solutions for the problem. Nurse practitioners working in the Fast Tracks have sped things up tremendously. Of course, there are things that show up in Fast Tracks that are more critical than they appear, so we don’t just see the easy stuff. The idea that Nurse Practitioners should only see colds, diarrhea and sprains irritates the many of us who have the schooling and diagnostic skills to do emergent care. Nurse practitioners are specializing in emergent and critical ICU care, as well as those of us who work in primary care offices. Just ask Diary of A New Emergency Room NP.

The main reason for emergency room waits is the sheer volume of patients who come in for non-emergent care. If people would go to their primary care providers for things that aren’t emergencies, then the wait times would go down. Too often people go in for cold symptoms and are not in distress. The wait times are not all that bad considering that we live in a country with a great health care system. Why are we turning into such a “gimme gimme, fix it now!” society? If you lived in a third world country, you may have to wait camped outside for days and may never get to see a medical provider at all. I would never consider going to the emergency room unless I thought it were a truly emergent issue. Some nurses, like Kim from Emergiblog, have got to be saints for putting on their smiles and not actually making a patient’s cold symptoms into respiratory distress by putting a pillow over their heads! Just kidding!! I can’t imagine working like a dog trying save a child’s life after a car accident and then having to go into a room where someone has back pain that is chronic for years and just wants pain meds and a note off of work for Monday.
Kudos those nurses who can work in that scenario daily without losing their ever loving minds.

Some of the problems reside around the fact that a lot of patients have no insurance. They are not sure where to go so the ED is the first place they head to. I work for a rural office that does a sliding fee payment schedule and often the local ED sends patients to me for follow up. I make sure that my patients understand that I am on call for my patients 24 hours and that they need to call the office triage nurse (who will call me) BEFORE they go their local emergency rooms for problems. We also do same day scheduling. This makes it easier for patients to come in when they are sick and not have to wait until they are so far gone that the ED is their only option for relief. I explain to patients with no insurance that I can save them thousands of dollars.

Before most people get into the screaming game of patients who don’t have insurance can’t afford 90.00 to 160.00 for an initial visit, lets start looking at the ones who show up COVERED in gold jewelery and talking on cellphones. If the patient has to choose between paying the cost of a test or the cost of the office visit, I tell them to pay the test fee first. We can always work out a payment plan. Most offices who just carry insurance have some kind of system for patients who can’t afford things and as long as they don’t get abused, will keep them in place.

So, when you get cranky having to wait for several hours in an emergency room when you only have a non-emergent issue, remember that the doctors, nurses, and nurse practitioners are trying to save lives and it may be someone you love in there one day taking up all their time.

Hello to all who read my blog and thanks for making this year a great one for me through your support over the last year. I want to also thank my great sponsors for making it a profitable year and hope that you will continue to benefit being on my blog site.

Thanks for all who left comments on my posts and they are very welcome regardless if you agree with me or not. I welcome the student nurses and student NPs who have stopped by ( I see you on my sitemeter). I just wish that I could visit your boards and see what is being said about my site. Email me a password or something will ya? It’s killing me!

I have been blessed with a new grandson this year and the oldest one is growing like a weed and is just as cute as ever. It’s hard to believe that I am a Noni at the ripe old age of 42. It’s an entirely different love to give. You should try it! The hubby is doing better at taking his meds once he found out his cholesterol was 700 and his triglycerides are 4400. His AIC was 13.9. Yes…. He knows that he is a walking heart attack but is promising to take his doctor’s and my advice and has already lost 50 lbs this year.

The Navy son is home for two weeks before going to Jacksonville for some more training. He gets dropped off somewhere for survival training soon. I hope all that time playing in the woods paid off when he was little. The youngest son is doing great in 6th grade this year. Not such a hassle being picked on now that he is growing a little taller. It’s hard to resist going down there are giving those little devils the what for!

If you haven’t heard, I got awesome news this year recently having been accepted by the HRSA National Student Loan Payback program and will receive 50,000 off of my student loans for working an additional two years at my current job which I love! How cool is that? I also have the opportunity to extend it another year for a additional 25,000 off I think. Don’t let that slow you all down “supporting the site” and you have been doing so well. Remember to let me know when you have done it so that I can make sure to return the favor. If I see ads on sites, I always “support the sponsors” because I know how bad the loans can be. Thanks again!

There have been a few sad events this year. Emily found out that her Mom has breast cancer, Barbara lost her Mother, and my neighbor lost her husband to a stroke the other day after 42 years of marriage. One just never knows so make sure that you take some extra time to say I love you to all those you hold dear this year.

Off I go to make some more pies for tomorrow and feed my fish and do some farming on Facebook! When you get a minute, Change of Shift if up over at Emergiblog for your perusal. Enjoy!

Hello to all! I hope you are all about ready for Christmas! I finished my shopping today and am looking forward to seeing the grandchildren. Time is flying by and Michael is also home from the Navy for a two week visit before moving over to Jacksonville for more training. He is doing well and we are so proud.

One of the things that I needed this year was a new lab coat. I tend to go through several of them because I can’t seem to keep the ink off of them. I recently bought a lab coat from Barry at mynursinguniforms.com and it arrived very quickly. I chose a Cherokee Professional Whites lab coat and I figured I would give his company a try. I was given a coupon in return for writing a review of the process. Barry is also interested in becoming a paid advertiser on my nurse practitioner blogs so make sure that you go over and visit his site from mine so he will agree to help support my site too.

The hubby asked me what I wanted for Christmas this year and I told him not anything too expensive. Since I received the National Student Loan Payback this year, I seem to be focused on getting the rest of that paid down so when I extend it for another year that I may be able to get it taken care of quickly. What a huge relief that there really is an end to the school debt tunnel. Of course, to all who have “supported my site” over the years as I’ve transitioned from a student NP to a practicing one, I thank you and hope that you will let me know to visit your site and return the favor.

Merry Christmas to all who stop by and I hope that your 2010 will be a great as you want it to be!!

I hope everyone is having a great Thanksgiving holiday. I am eagerly waiting for the turkey to get finished and am spending time with family. Mike is spending Thanksgiving on the Naval base in Pensacola. I am so proud of his serving his country. Ciara is spending Thanksgiving with me today too. I don’t get enough time with her and will enjoy every minute. Brenton and Krista and baby Clayton are spending the holiday with her parents.

I received some awesome news the other day. I have been accepted for the National Health Service Corp’s student loan payback. I will work for the next two years at a job I already love and get $50,000 paid off my loans. I am waiting for the deposit so that I can pay it to Sallie Mae. I can apply for an additional year extension and get some more paid off as well. How great is that!!! If you work in a rural area and haven’t applied, do it now. They are not taking into consideration the HPSA score during this time frame and the application is much shorter now.

The office is getting very busy and am attempting to stay ahead of the never ending paperwork. One of the other branches is now getting their expansion done and we are next on the list. We will be building from the ground up and I can’t wait for it to be done. We are tripping over each other in the office and there is only one bathroom in the office for everyone. Makes for interesting times! I am getting the week of Christmas off and am only having to use three days of comp time to do it. I love getting four day weekends as we get the Friday after a holiday off if it falls just right.

Have a safe holiday everyone and I hope that you all stop by to say hello soon!

Below is Peter Ferrara’s opinion of the Health Care Reform Bill that is being considered. I am offended by two points that he makes while referencing health care providers. Read and then go to below to see what I was having a problem with..

One confusion arising from the House bill is that its provisions are phased in over several years. Over the first 10 years of full operation, the House bill actually cuts Medicare by $800 billion, as scored by CBO. The cuts for Medicare Advantage plans will be close to $200 billion, and despite President Obama’s phony shtick that if you like your health plan you can keep it, the Administration itself estimates that 8 million seniors will lose their Medicare Advantage plan as a result, 73% of those with such plans.

This is the beginning of health care rationing for seniors, as the payments to their doctors and hospitals for the care that currently maintains their health will be slashed back. In addition, as Betsy McCaughey explains in the Journal, the House bill moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what’s called a “medical home.” The medical home is this decade’s version of HMO restrictions on care. A primary care provider manages access to costly specialists and diagnostic tests for a flat monthly fee. The bill specifies that patients may have to settle for a nurse practitioner rather than a physician as the primary care provider. Medical homes begin with demonstration projects, but… HHS…is authorized to “disseminate this approach rapidly on a national basis.”

What this means is that your doctor is paid a flat monthly fee for your care, and referring you to a specialist or for a diagnostic test effectively comes out of his pocket. So if you need an MRI or a CT scan to see if you have cancer, or to check if that pain in your chest is due to clogged arteries, or if you need to see a specialist to treat cancer or heart disease, the doctor has a financial interest to delay or deny it. Financially, if you are actually this sick, he will be better off if you die sooner rather than later. That is the result of the perverted, inverse incentives the House health bill creates for medical providers.

I don’t like the inference that one would have to “settle” for a Nurse Practitioner. If you ask my patients, they will tell you that they prefer to see a NP over a physician anyway.

His idea that primary care providers are the gatekeepers is nothing new. It’s been that way since I can remember. Most specialists require referrals from a patient’s primary.

My biggest gripe is the insinuation that ANY health care provider would EVER not use whatever resources it takes to accurately diagnose a patient. If a doctor or NP or PA ever kept a patient from being diagnosed because it would take money out of their own pockets, they should be run out of health care immediately! True health care professionals are not just in it for the money. They really like helping patients and feel a moral obligation to do so. Of course we all need to pay the bills and I can’t afford to do it for free. One day, I will be able to donate my services as so many do. Till then, I will keep on taking care of the patients who prefer me! Carry on..

P.S. This is the response I left on this blog article.

I find it a little insulting that you think that patients “settle” for a NP. My patients prefer me to other physicians and will tell you so. I am a great health care provider with patients who actually come back and do the necessary maintenance to remain as healthy as they can be. I serve in a rural community who is having a very hard time attracting physicians. I find it appalling that you would think that any health care provider would keep a patient from appropriate testing in order to line their own pockets. If they are doing so, they need to be run out of health care. I take care of patients because it’s a calling and not just because it pays well. I am curious to see if you have ever seen a nurse practitioner in action before you make snap judgments about the quality of our care.

Once again it’s Nurse Practitioner’s week. Please take some time and visit your favorite NP and let them know just how much you appreciate their hard work and time taking care of you and yours. Also, stop by and leave a nice comment on your favorite NP’s blogsite. They’ll love it!